To the original poster - I am not sure what midwifery journals you are reading, but I can imagine any that would discuss TTTS treatment to any great detail. It is not even something that is treated by general obstetricians. In fact, in Canada, there are less than a handful of physicians who can treat the condition.
I don't really care what you do, because ultimately this is your choice. However, if you are in fact carrying twins or triplets, I pray that they will not suffer for your decisions. I understand that this is a UC/UP board, but in all fairness you have brought up the topic of TTTS, not with the most clear or accurate information.
However, for anyone else who comes across this board, I think some information should be clarified.
TTTS - Twin to Twin transfusion syndrome. It is an abnormality of the placenta in twins who are monochorionic/diamniotic. The placenta is made up of many small functional segments called cotelydons. Each is supplied by one artery and one vein. The artery takes blood pumped from the heart to the placenta to be oxygenated and to receive nutrients and the vein returns to to the baby. In Mono/di twin pregnancies, the cotelydons are not always shared equally. The placenta develops its structure first, then connects the blood vessels. As a result, one baby may have more than its fair share of cotelydons. This risk is greater when one cord attaches to the middle of the placenta and one attaches to the edge. This can result in differences in growth related to the proportion of placenta supplying each baby.
The blood vessel may develop connections between the babies, almost invariably with mono/di twins. There are three types of connections. Artery-artery which are the less common and may affect ultrasound assessments of the umbilical cord. They do not seem to be protective or harmful. Vein-vein connections are low pressure connections that allow blood flow in either direction. They can be like a release valve if one baby gets too much fluid. However, they can be collapsed with excessive fluid (polyhydramnios), thereby worsening the condition once it starts to develop. The final connections are the artery-vein connections. It is not a direction connection persay, but rather one baby pumps blood to a particular cotelydon, the blood enters the microscopic vessels there to drain into the vein, but that vein drains to the other baby. This is a one way system - blood only flows one direction. If these A-V connections are minimal or balanced, or there are enough V-V connections to allow the return of blood, TTTS will not occur. However, in 15% of mono/di twins, these blood vessels cause an imbalance and there is a donor twin that is constantly sending more blood to the recipient twins. This is TTTS.
The blood vessels are abnormal from the very beginning, and if it is going to occur, its from early on the problem has existed. We watch all mono/di twins closely, because without intervention, it is often lethal. For triplets with a mono/di twin set, the same is true, because the recipient twin will develop polyhydramnios and likely cause preterm labour and without treatment, all will likely be lost, whereas with treatment there is still a risk, but not nearly as great. We look for fluid difference between the babies, and this can be present as early at 10 weeks. In the first trimester, the babies don't enough to actually make of the fluid, but sometimes they have more fluid in their bodies, so the nuchal translucency measurement can be very different between the two. Starting at 16 weeks, ultrasound are done every two weeks, and more often if there is a difference in the fluid. Once TTTS is diagnosed, the highly speciallized MFMs are involved in determining the optimal time for laser surgery. Yes, this carries a risk, but less than that of not treating the condition. In cases of triplets, they do wait until the TTTS is more severe to be sure that the treatment is the last option, but it is still done. The surgery is safest under 24-26 weeks.
We can all argue why these vessel form connections like this, or whether there are maternal factors, but the fact is that this is a placental condition. Therefore, the treatment is to destroy the harmful A-V connections without otherwise hurting the placenta. This is done with a laser inserted into the uterus, and only a select few MFM's are qualified to do this (it actually requires extra training beyond fellowship). After 24-26 weeks, surgery is often not done because of safety. If the condition is worsen quickly, one can try to improve things by removing the extra fluid to re-open the V-V connections. Later, delivery may be the best treatment.
However, this is all very specialized, and I seriously doubt it is included in midwifery text. Furthermore, I respect your decision to care for you pregnancy however you wish, but I think it is not appropriate to suggest to others that you are making well informed choices. You do not have enough accurate information to be doing that, so you are making you choices on faith, not fact. (Again, your choice).
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